血浆D-二聚体及纤维蛋白原在AECOPD患者中的变化及利伐沙班干预疗效评价

目的 探索血浆D-二聚体及纤维蛋白原在慢性阻塞性肺疾病急性加重期（AECOPD）患者中的变化以及利伐沙班对其干预的疗效评价。方法 选择2016年1月-2018年4月在徐州医科大学第二附属医院呼吸内科就诊的确诊慢性阻塞性肺疾病（COPD）患者120例，AECOPD组与COPD稳定期对照组各60例，选择同期在此院健康体检者62例作为对照，均于早晨空腹静脉采血，比较3组研究对象的D-二聚体及纤维蛋白原水平；将AECOPD患者随机分为两组，即利伐沙班组和低分子肝素组，每组30例，分别在常规治疗的基础上口服利伐沙班药物及皮下注射低分子肝素，比较两组的疗效。结果 AECOPD组患者的血浆D-二聚体及纤维蛋白原水平高于稳定期对照组及健康体检组，差异具有统计学意义（P<0.05）。稳定期对照组患者D-二聚体浓度及纤维蛋白原水平高于健康体检组，但差异无统计学意义。患者经利伐沙班或低分子肝素治疗后血浆D-二聚体、纤维蛋白原水平均较治疗前降低，差异具有统计学意义（P<0.05）；利伐沙班组患者经治疗后D-二聚体水平低于低分子肝素组（P<0.05），纤维蛋白原水平组间差异无统计学意义；pO₂均较治疗前有所上升，pCO₂均治疗前有所降低，血气分析指标明显改善（P<0.05），但两组间差异均无统计学意义；低分子肝素组治疗AECOPD患者总有效率（73.33%）略低于利伐沙班组（80.00%），但差异无统计学意义。结论 AECOPD患者的血浆D-二聚体及纤维蛋白原水平高于稳定期患者及健康者，血液处于高凝状态。利伐沙班与低分子肝素两种药物的疗效接近，但利伐沙班克服了低分子肝素与传统口服抗凝药的局限，在临床治疗AECOPD患者中具有更好的应用价值。

Changes of plasma D-dimer and fibrinogen in patients with AECOPD and efficacy evaluation of rivaroxaban intervention

Objective To explore the changes of plasma D-dimer and fibrinogen in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the efficacy of rivaroxaban for its intervention. Methods Selected 120 cases with COPD diagnosed in Department of Respiratory Medicine, Second Affiliated Hospital of Xuzhou Medical University from January 2016 to April 2018, we divided the cases into two group:the group in AECOPD and the group in stable phase of Chronic Obstructive Pulmonary Disease, 60 cases in each group. At the same time, we select 62 adults with health examination as normal control group in the hospital physical examination center. The above three groups of subjects all collected blood in the morning with a fasting vein, comparison among the three groups of differences in the levels of plasma D-dimer and fibrinogen. We randomly divided AECOPD patients into two groups of 30 patients in each group. Patients in the two groups received oral rivaroxaban and subcutaneous injections of low molecular weight heparin on the basis of routine treatment respectively, compare the efficacy of the two groups. Results The plasma D-dimer and fibrinogen levels in the AECOPD group were higher than those in the stable control group and the healthy examination group (P<0.05).The D-dimer and fibrinogen levels in the stable control group were higher than those in the healthy group, but the difference was not statistically significant. The plasma levels of D-dimer and fibrinogen in patients after treatment with rivaroxaban or low-molecular-weight heparin were lower than those before treatment, and the difference was statistically significant (P<0.05). In the rivaroxaban group, D-dimer levels were lower than those in the low-molecular-weight heparin group (P<0.05), and there was no significant difference in fibrinogen levels between the two groups. pO₂ increased compared with before treatment, pCO₂ decreased before treatment, blood gas analysis index improved significantly (P<0.05), but there was no significant difference between the two groups. The total effective rate of patients with AECOPD in the low-molecular-weight heparin group (73.33%) was slightly lower than that in the rivaroxaban group (80.00%), but the difference was not statistically significant. Conclusion The plasma D-dimer and fibrinogen levels in patients with AECOPD were higher than those in stable patients and healthy individuals, and the blood was hypercoagulated. The efficacy of rivaroxaban and low molecular weight heparin is similar, but rivaroxaban overcomes the limitations of low molecular weight heparin and traditional oral anticoagulants, and has a better application value in clinical treatment of AECOPD patients.